the pcl on monday is not about the ankle, its about a fracture to the lower leg. so from wut i understand its again in sarawak, and i think we shud look into emergency treatment of fractures and also the emergency services provided in rural areas such as sarawak. other than that there isnt much else that i feel is needed, but guys pls do read it and look into wutever u think is important in this pcl and share with the rest. maybe can look into different type of fractures in the lower leg. happy studying guys, hope u can do a ltl research for pcl as well =) tc
Saturday, October 10, 2009
Thursday, October 8, 2009
Hello! :)
Just bored. :)
All the best for OSCE tomorrow. AND REMEMBER TO :
i ) wear formal clothing.
ii ) bring your white coat.
iii) bring your monash ID.
:) See you guys tomorrow! :)
All the best for OSCE tomorrow. AND REMEMBER TO :
i ) wear formal clothing.
ii ) bring your white coat.
iii) bring your monash ID.
:) See you guys tomorrow! :)
Wednesday, October 7, 2009
anatomy prac week 11 knee
Q1 - jas ridzuan and the srilankan
Q2 - jess arma chang thai
Q3 - zhi mie, syukriah daksha
Q4 - me and sandy
Q5 - carmen
Q2 - jess arma chang thai
Q3 - zhi mie, syukriah daksha
Q4 - me and sandy
Q5 - carmen
Tuesday, October 6, 2009
Treatment and Management : Other Knee Injuries.
PLUS preventive measures.
Muscle Tendon Injuries : First aid and ibuprofen.
The mechanism of injury is either hyperextension, in which the hamstring muscles can be stretched or torn, or hyperflexion, in which the quadriceps muscle is injured. Rarely with a hyperflexion injury, the patellar or quadriceps tendon can be damaged. This injury is characterized by the inability to extend the knee and a defect that can be felt either above or below the patella. Surgery is required to repair this injury.
MCL and LCL Injuries : ligaments can be stretched or torn when the foot is planted and a sideways force is directed to the knee. This can cause significant pain and difficulty walking as the body tries to protect the knee, but there is usually little swelling within the knee. RICE are the mainstays of treatment.
Fractures : surgery will be required for repair, but if the bone is in good position, a knee immobilizer and watchful waiting may be all that is required.
Bursa Inflammation : Housemaid's knee is due to repetitive kneeling and crawling on the knees. The bursa or space between the skin and kneecap becomes inflamed and fills with fluid. It is a localized injury and does not involve the knee itself. Treatment includes padding the knee and using ibuprofen as an anti-inflammatory medication.
Patellar Injuries : The kneecap sits within the tendon of the quadriceps muscle, in front of the femur, just above the knee joint. It is held in place by the muscles of the knee.
Prevention
Having strong and flexible quadriceps and hamstring muscles can prevent minor stresses to the knee from causing significant injury.
Proper footwear can also minimize the risk for knee injury.
Wearing shoes that are appropriate for the activity can lessen the risk of twisting that can stress the knee.
References :
http://www.webmd.com/a-to-z-guides/anterior-cruciate-ligament-acl-injuries-treatment-overview
http://emedicine.medscape.com/article/826792-treatment
http://www.emedicinehealth.com/knee_injury/page7_em.htm
http://www.emedicinehealth.com/knee_injury/page8_em.htm
Muscle Tendon Injuries : First aid and ibuprofen.
The mechanism of injury is either hyperextension, in which the hamstring muscles can be stretched or torn, or hyperflexion, in which the quadriceps muscle is injured. Rarely with a hyperflexion injury, the patellar or quadriceps tendon can be damaged. This injury is characterized by the inability to extend the knee and a defect that can be felt either above or below the patella. Surgery is required to repair this injury.
MCL and LCL Injuries : ligaments can be stretched or torn when the foot is planted and a sideways force is directed to the knee. This can cause significant pain and difficulty walking as the body tries to protect the knee, but there is usually little swelling within the knee. RICE are the mainstays of treatment.
Fractures : surgery will be required for repair, but if the bone is in good position, a knee immobilizer and watchful waiting may be all that is required.
Bursa Inflammation : Housemaid's knee is due to repetitive kneeling and crawling on the knees. The bursa or space between the skin and kneecap becomes inflamed and fills with fluid. It is a localized injury and does not involve the knee itself. Treatment includes padding the knee and using ibuprofen as an anti-inflammatory medication.
Patellar Injuries : The kneecap sits within the tendon of the quadriceps muscle, in front of the femur, just above the knee joint. It is held in place by the muscles of the knee.
Prevention
Having strong and flexible quadriceps and hamstring muscles can prevent minor stresses to the knee from causing significant injury.
Proper footwear can also minimize the risk for knee injury.
Wearing shoes that are appropriate for the activity can lessen the risk of twisting that can stress the knee.
References :
http://www.webmd.com/a-to-z-guides/anterior-cruciate-ligament-acl-injuries-treatment-overview
http://emedicine.medscape.com/article/826792-treatment
http://www.emedicinehealth.com/knee_injury/page7_em.htm
http://www.emedicinehealth.com/knee_injury/page8_em.htm
Treatment and Management : ACL
Because this is the focus of other PCL groups. HAHA. I suspect this is the 'main' topic.
Anterior Cruciate Ligament (ACL) Injury
Based on three factors :
i) Age
ii) Functional disability
iii) Functional requirements
Treatment goals :
i) To stabilize the knee if it is unstable, or at least stabilize it enough to suit the patient’s lifestyle.
ii) To return the knee to normal or almost normal functioning.
iii) To reduce the likelihood of further damage to the knee, help to reduce pain, prevent osteoarthritis, and prevent loss of strength and decreased movement in the knee.
Initial treatment :
First aid steps to reduce swelling and pain.
PROTECT the knee from further trauma.
o This can be done with knee padding.
o A pad over the kneecap, for example, helps to control the symptoms of some knee injuries (an example is a form of bursitis sometimes called housemaid's knee) by preventing further repetitive injury to the prepatellar bursae.
REST the knee.
o Rest reduces the repetitive strain placed on the knee by activity.
o Rest both gives the knee time to heal and helps to prevent further injury.
ICE the knee.
o Icing the knee reduces swelling and can be used for both acute and chronic knee injuries.
o Most authorities recommend icing the knee 2-3 times a day for 20-30 minutes each time.
o Use an ice bag or a bag of frozen vegetables placed on the knee.
COMPRESS the knee with a knee brace or wrap.
o Compression helps accomplish 2 goals:o First, compression is another way to reduce swelling.
o Second, in some knee injuries, compression can be used to keep the patella aligned and to keep joint mechanics intact.
ELEVATE the knee.
o Elevation also helps reduce swelling.
o Elevation works with gravity to help fluid that would otherwise accumulate in the knee flow back to the central circulation.
o Prop your leg up when you are sitting, or use a recliner, which naturally elevates the legs.
If first aid fails to relieve pain, then use:
· Simple analgesics and NSAIDs.
· Using crutches and/or immobilizing splints in the first few days after an injury. If crutches or splints are used for too long, the muscles will become weaker from too little activity, and movement of the knee will become stiff and restricted.
Later treatment : several months of rehabilitation or surgery with rehabilitation. But these futher treatment depend on:
How much of the ACL is torn (whether it is a grade I, II, or III sprain).
When the injury occurred and how stable is the knee.
If there are other parts injuries.
Pre existing conditions of the knee, such as prior injuries that resulted in long-term (chronic) ACL deficiency, or OA.
Risk factors : age, gender, overall health status.
Treatment options include:
Nonsurgical treatment : Physical rehabilitation program, wearing a brace and avoidance of over strenuous activities.
ACL surgery : reconstruct the ACL or to reconstruct the ACL and repair injuries that occurred at the same time, such as a meniscus tear- Done by making small incisions in the knee and inserting instruments for surgery through these incisions (arthroscopic surgery). Open surgery (cutting a larger incision in the knee) is sometimes required. Physical rehabilitation always follows surgery.
Anterior Cruciate Ligament (ACL) Injury
Based on three factors :
i) Age
ii) Functional disability
iii) Functional requirements
Treatment goals :
i) To stabilize the knee if it is unstable, or at least stabilize it enough to suit the patient’s lifestyle.
ii) To return the knee to normal or almost normal functioning.
iii) To reduce the likelihood of further damage to the knee, help to reduce pain, prevent osteoarthritis, and prevent loss of strength and decreased movement in the knee.
Initial treatment :
First aid steps to reduce swelling and pain.
PROTECT the knee from further trauma.
o This can be done with knee padding.
o A pad over the kneecap, for example, helps to control the symptoms of some knee injuries (an example is a form of bursitis sometimes called housemaid's knee) by preventing further repetitive injury to the prepatellar bursae.
REST the knee.
o Rest reduces the repetitive strain placed on the knee by activity.
o Rest both gives the knee time to heal and helps to prevent further injury.
ICE the knee.
o Icing the knee reduces swelling and can be used for both acute and chronic knee injuries.
o Most authorities recommend icing the knee 2-3 times a day for 20-30 minutes each time.
o Use an ice bag or a bag of frozen vegetables placed on the knee.
COMPRESS the knee with a knee brace or wrap.
o Compression helps accomplish 2 goals:o First, compression is another way to reduce swelling.
o Second, in some knee injuries, compression can be used to keep the patella aligned and to keep joint mechanics intact.
ELEVATE the knee.
o Elevation also helps reduce swelling.
o Elevation works with gravity to help fluid that would otherwise accumulate in the knee flow back to the central circulation.
o Prop your leg up when you are sitting, or use a recliner, which naturally elevates the legs.
If first aid fails to relieve pain, then use:
· Simple analgesics and NSAIDs.
· Using crutches and/or immobilizing splints in the first few days after an injury. If crutches or splints are used for too long, the muscles will become weaker from too little activity, and movement of the knee will become stiff and restricted.
Later treatment : several months of rehabilitation or surgery with rehabilitation. But these futher treatment depend on:
How much of the ACL is torn (whether it is a grade I, II, or III sprain).
When the injury occurred and how stable is the knee.
If there are other parts injuries.
Pre existing conditions of the knee, such as prior injuries that resulted in long-term (chronic) ACL deficiency, or OA.
Risk factors : age, gender, overall health status.
Treatment options include:
Nonsurgical treatment : Physical rehabilitation program, wearing a brace and avoidance of over strenuous activities.
ACL surgery : reconstruct the ACL or to reconstruct the ACL and repair injuries that occurred at the same time, such as a meniscus tear- Done by making small incisions in the knee and inserting instruments for surgery through these incisions (arthroscopic surgery). Open surgery (cutting a larger incision in the knee) is sometimes required. Physical rehabilitation always follows surgery.
Treatment and Management : General Knee Injury
So I've got loads of information from this website which I think is adequate for this week's PCL. But no matter, will post them up, part by part. The references are at the last post okay? Will definitely be simplifying things for Friday. This could just take up 30 minutes of our time. HAHA. :
Prehospital Care
Stabilizing the lower extremity and monitoring the neurovascular status of the limb.
Should be realigned only if associated neurovascular structures are compromised.
Always recheck and document pulses after splinting or manipulation of the limb.
If initial efforts meet with resistance, prehospital personnel should not force realignment.
Cover open wounds with saline-soaked sterile gauze.
Emergency Department Care
Always determine the mechanism of injury and verify hemodynamic stability.
Assess vascular perfusion and control any bleeding.
Hard signs of vascular injury include absent or diminished pulses, active hemorrhage, and expanding or pulsatile hematoma.
Signs of distal ischemia include pain out of proportion to the injury, pallor, paralysis, and paresthesias.
For knee dislocations or grossly malaligned fractures with potential vascular compromise, attempt immediate reduction or realignment of the knee if an orthopedic specialist is not immediately available.
Observe for signs and symptoms of compartment syndrome. Measurement of compartment pressures is often needed to exclude the possibility of compartment syndrome.
Remove any constricting clothes and bandages.
Consider splinting the injured knee to provide support and to prevent further injury.
Serviceable devices include commercially available immobilizers and handcrafted compressive dressings, such as the Robert Jones dressing, which incorporates coaptation plaster.
Detrimental effects of immobilization include joint stiffness, degenerative changes in articular cartilage, muscle atrophy and weakness, and decreased vascularity.
Therapy for specific injuries
For first-degree sprains :RICE regimen. Normal function usually returns quickly.
Second-degree sprains : require protection by using a cast, cast brace, or a restrictive movement brace. Arrange for timely follow-up care.
Third-degree sprains : depends on the severity and type of instability; some third-degree sprains of ligaments necessitate surgical repair. Factoring into the deliberation for surgery is the patient's age, relative health, associated injuries, activity demands, and individual desires.
Pharmacological treatment
Nonnarcotic analgesics
acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)
Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)
Most commonly ingested pain reliever; marketed in combination with other drugs to provide analgesia.
Acetylsalicylic acid (Bayer Aspirin, Bufferin, Anacin, Ecotrin)
Prototype NSAID; used in combination with many other drugs; available OTC. Offers anti-inflammatory benefits, unlike acetaminophen. Effective in PO, suppository, and topical preparations.
Ketorolac (Toradol)
Frequently overlooked fact is that this medication is an NSAID, with all of the group's attendant risks and that it costs almost 20 times more than morphine (and 140 times more than ibuprofen). Data supporting superiority over other analgesics scarce.
Ibuprofen (Motrin, Advil, Nuprin)
Widely used NSAID, also available OTC, derivative of propionic class of NSAIDs and considered safest of NSAIDs. Advise taking with food or milk if possible; caution in children with flulike illnesses.
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy
Narcotic analgesics
Patients reporting inadequate pain relief from NSAIDs may benefit from short-term supplementation with an opioid compound. A wide array of products is available. Common adverse effects include constipation, nausea, respiratory depression, sedation, and urinary retention.
Hydrocodone and acetaminophen (Vicodin, Lorcet, Lortab, Anexsia)
Drug combination indicated for relief of moderately severe to severe pain.
Oxycodone and acetaminophen (Percocet, Tylox, Roxicet)
Drug combination indicated for relief of moderately severe to severe pain.
Acetaminophen and codeine (Tylenol #3)
Drug combination indicated for treatment of mild to moderately severe pain.
Morphine sulfate (Oramorph, MS Contin, Duramorph)
Criterion standard for relief of acute severe pain; may be administered in a number of ways; commonly titrated until desired effect obtained. IV morphine demonstrates half-life of 2-3 h; however, half-life may be 50% longer in the elderly.
Meperidine (Demerol)Narcotic analgesic with multiple actions similar to morphine; however, may cause less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine
Prehospital Care
Stabilizing the lower extremity and monitoring the neurovascular status of the limb.
Should be realigned only if associated neurovascular structures are compromised.
Always recheck and document pulses after splinting or manipulation of the limb.
If initial efforts meet with resistance, prehospital personnel should not force realignment.
Cover open wounds with saline-soaked sterile gauze.
Emergency Department Care
Always determine the mechanism of injury and verify hemodynamic stability.
Assess vascular perfusion and control any bleeding.
Hard signs of vascular injury include absent or diminished pulses, active hemorrhage, and expanding or pulsatile hematoma.
Signs of distal ischemia include pain out of proportion to the injury, pallor, paralysis, and paresthesias.
For knee dislocations or grossly malaligned fractures with potential vascular compromise, attempt immediate reduction or realignment of the knee if an orthopedic specialist is not immediately available.
Observe for signs and symptoms of compartment syndrome. Measurement of compartment pressures is often needed to exclude the possibility of compartment syndrome.
Remove any constricting clothes and bandages.
Consider splinting the injured knee to provide support and to prevent further injury.
Serviceable devices include commercially available immobilizers and handcrafted compressive dressings, such as the Robert Jones dressing, which incorporates coaptation plaster.
Detrimental effects of immobilization include joint stiffness, degenerative changes in articular cartilage, muscle atrophy and weakness, and decreased vascularity.
Therapy for specific injuries
For first-degree sprains :RICE regimen. Normal function usually returns quickly.
Second-degree sprains : require protection by using a cast, cast brace, or a restrictive movement brace. Arrange for timely follow-up care.
Third-degree sprains : depends on the severity and type of instability; some third-degree sprains of ligaments necessitate surgical repair. Factoring into the deliberation for surgery is the patient's age, relative health, associated injuries, activity demands, and individual desires.
Pharmacological treatment
Nonnarcotic analgesics
acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)
Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)
Most commonly ingested pain reliever; marketed in combination with other drugs to provide analgesia.
Acetylsalicylic acid (Bayer Aspirin, Bufferin, Anacin, Ecotrin)
Prototype NSAID; used in combination with many other drugs; available OTC. Offers anti-inflammatory benefits, unlike acetaminophen. Effective in PO, suppository, and topical preparations.
Ketorolac (Toradol)
Frequently overlooked fact is that this medication is an NSAID, with all of the group's attendant risks and that it costs almost 20 times more than morphine (and 140 times more than ibuprofen). Data supporting superiority over other analgesics scarce.
Ibuprofen (Motrin, Advil, Nuprin)
Widely used NSAID, also available OTC, derivative of propionic class of NSAIDs and considered safest of NSAIDs. Advise taking with food or milk if possible; caution in children with flulike illnesses.
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy
Narcotic analgesics
Patients reporting inadequate pain relief from NSAIDs may benefit from short-term supplementation with an opioid compound. A wide array of products is available. Common adverse effects include constipation, nausea, respiratory depression, sedation, and urinary retention.
Hydrocodone and acetaminophen (Vicodin, Lorcet, Lortab, Anexsia)
Drug combination indicated for relief of moderately severe to severe pain.
Oxycodone and acetaminophen (Percocet, Tylox, Roxicet)
Drug combination indicated for relief of moderately severe to severe pain.
Acetaminophen and codeine (Tylenol #3)
Drug combination indicated for treatment of mild to moderately severe pain.
Morphine sulfate (Oramorph, MS Contin, Duramorph)
Criterion standard for relief of acute severe pain; may be administered in a number of ways; commonly titrated until desired effect obtained. IV morphine demonstrates half-life of 2-3 h; however, half-life may be 50% longer in the elderly.
Meperidine (Demerol)Narcotic analgesic with multiple actions similar to morphine; however, may cause less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine
A MESSAGE TO ZHI MEI
okie...after discussing with viran, here's the points:
1) ligaments - ACL (twisted) ; - PCL (direct blow)
2) meniscus - violent twisting
3)tendons - overuse (playing sports, riding bicycle, running ( jumper's knee);
- torn ( fall,weakened tendons(elderly))
4)fracture - direct trauma to knee (fall or car accident)
5)bursitis -due to overuse
I'll focus on twisted and direct blow ( therefore i'll do on ligaments and fracture and meniscus)
You'll focus on overused and torn tendon ( meaning tendons and bursitis).....
We could have a discussion on thursday night whether to compile it or not...if i can finish it...:-(....i'l try by best ya!!
PCL week 11 task delegation
Hey guys and girls,
this is the rough draft of how the presentations will go on friday :) that i hav come with off the top of my head at 12.45 in the morning. so if u feel there is any changes tht should be made to it pls let me kno.. thank you.
1. Anatomy of the knee, accute anxiety and hyperventilation - Chang Thai.
2. Epidemiology - gender
occupation and activities
worst outcome
prognosis and disease progression - Syukriah and Arma
3. Knee injury- general causes and risk factors
- commonest cause of knee injury epid - Viran and Daksha
4. Signs and symptoms
Pathogenesis and complications - Jasmine and Zhi Mei
5. Investigation, diagnosis and full examination of knee - Jesslyn and Shakir
6. First Aid, Management and Treatment - Sandhya and Carrmen
7. Ethical and Legal Issues - Ridzuan
**** pls let me kno if i hav got wut ur doin correctly cos im not sure of syukriah and shakir if i got it right....
Monday, October 5, 2009
Sunday, October 4, 2009
First Aid.
PRICE
PROTECT the knee from further trauma.
o This can be done with knee padding.
o A pad over the kneecap, for example, helps to control the symptoms of some knee injuries (an example is a form of bursitis sometimes called housemaid's knee) by preventing further repetitive injury to the prepatellar bursae.
REST the knee.
o Rest reduces the repetitive strain placed on the knee by activity.
o Rest both gives the knee time to heal and helps to prevent further injury.
ICE the knee.
o Icing the knee reduces swelling and can be used for both acute and chronic knee injuries.
o Most authorities recommend icing the knee 2-3 times a day for 20-30 minutes each time.
o Use an ice bag or a bag of frozen vegetables placed on the knee. ( Veges? HAHAHAHA. See, CThai, greens are good for you!! )
COMPRESS the knee with a knee brace or wrap.
o Compression helps accomplish 2 goals:
o First, compression is another way to reduce swelling.
o Second, in some knee injuries, compression can be used to keep the patella aligned and to keep joint mechanics intact.
ELEVATE the knee.
o Elevation also helps reduce swelling.
o Elevation works with gravity to help fluid that would otherwise accumulate in the knee flow back to the central circulation.
o Prop your leg up when you are sitting, or use a recliner, which naturally elevates the legs.
If first aid fails to relieve pain ..
• Over-the-counter pain control medications: Commonly used pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve or Naprosyn) and ibuprofen (Advil or Motrin) also play a role in the treatment of knee pain.
o These drugs directly control pain and, at higher doses, act as anti-inflammatory agents, helping to break the inflammatory cycle. Like all medications, however, these drugs have side effects.
o Acetaminophen (Tylenol) can also be used to control knee pain but does not have the anti-inflammatory properties of the NSAIDs. Still, this treatment is remarkably useful in many types of knee pain such as osteoarthritis.
Reference :
http://www.emedicinehealth.com/pdfguides/first_aid/knee-pain-overview-treatment-61794.pdf
PROTECT the knee from further trauma.
o This can be done with knee padding.
o A pad over the kneecap, for example, helps to control the symptoms of some knee injuries (an example is a form of bursitis sometimes called housemaid's knee) by preventing further repetitive injury to the prepatellar bursae.
REST the knee.
o Rest reduces the repetitive strain placed on the knee by activity.
o Rest both gives the knee time to heal and helps to prevent further injury.
ICE the knee.
o Icing the knee reduces swelling and can be used for both acute and chronic knee injuries.
o Most authorities recommend icing the knee 2-3 times a day for 20-30 minutes each time.
o Use an ice bag or a bag of frozen vegetables placed on the knee. ( Veges? HAHAHAHA. See, CThai, greens are good for you!! )
COMPRESS the knee with a knee brace or wrap.
o Compression helps accomplish 2 goals:
o First, compression is another way to reduce swelling.
o Second, in some knee injuries, compression can be used to keep the patella aligned and to keep joint mechanics intact.
ELEVATE the knee.
o Elevation also helps reduce swelling.
o Elevation works with gravity to help fluid that would otherwise accumulate in the knee flow back to the central circulation.
o Prop your leg up when you are sitting, or use a recliner, which naturally elevates the legs.
If first aid fails to relieve pain ..
• Over-the-counter pain control medications: Commonly used pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve or Naprosyn) and ibuprofen (Advil or Motrin) also play a role in the treatment of knee pain.
o These drugs directly control pain and, at higher doses, act as anti-inflammatory agents, helping to break the inflammatory cycle. Like all medications, however, these drugs have side effects.
o Acetaminophen (Tylenol) can also be used to control knee pain but does not have the anti-inflammatory properties of the NSAIDs. Still, this treatment is remarkably useful in many types of knee pain such as osteoarthritis.
Reference :
http://www.emedicinehealth.com/pdfguides/first_aid/knee-pain-overview-treatment-61794.pdf
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